10 Scientific American, November 2019SCIENCE AGENDA
OPINION AND ANALYSIS FROM
SCIENTIFIC AMERICAN’S BOARD OF EDITORSIllustration by Rafa AlverezEnd Vaccine
Exemptions
Religious and philosophical exceptions
are too dangerous to public health
By the EditorsAs of late August, there had been more than 1,200 cases of
measles across 31 U.S. states this year. It’s a dispiriting come-
back for a disease that was declared eliminated in this country
in 2000. If the disease has not stopped spreading by the time
you read this, the U.S. will likely have lost this status. The ill-
ness has been cropping up mainly in pockets of unvaccinated
people. Those who choose not to immunize their families are
placing at risk not only themselves and their children but also
others who cannot be vaccinated because they are too young or
have medical issues.
There isn’t an iota of doubt that vaccines are an overwhelm-
ingly safe and effective way to prevent measles and other diseas-
es, including mumps, rubella, poliomyelitis and pertussis. All
50 states mandate that children entering school get immunized
unless they have a medical exemption. Yet almost every state also
offers religious exemptions, and more than a dozen offer person-
al belief/philosophical ones as well. California, Mississippi, West
Virginia, Maine and, most recently, New York State have gotten
rid of all nonmedical waivers. The others must follow suit. It’s
imperative for protecting public health.
It doesn’t take many unvaccinated people to cause an out-
break. Measles was one of the first vaccine-preventable diseas-
es to reappear because it is so contagious; the threshold for
resistance to a disease conferred by sufficient community-wide
levels of immunity or vaccination—so-called herd immunity—is
93 to 95 percent. If vaccination levels fall below that threshold,
an infected person can cause an outbreak.
Hesitancy about vaccines is nothing new. People have ques-
tioned inoculations since Edward Jenner discovered the small-
pox vaccine in 1796. Today vaccines are partly a victim of their
own resounding success. People rarely, if ever, see once common
diseases such as measles and polio, so they don’t understand
their potential danger. On top of that, relentless misinformation
campaigns have touted such false claims as the idea that vac-
cines cause autism. Numerous studies have shown they do not.
The discredited researcher Andrew Wakefield introduced this
idea in a now refuted study, and celebrities such as Jenny McCar-
thy and Robert F. Kennedy, Jr., have given it credence. And social
media has made it easier than ever for vaccine deniers to find
like-minded networks of people to confirm their false beliefs.
Despite the existence of religious exemptions to vaccines,
most major faith groups in the U.S. do not prohibit vaccination,
and many religious leaders encourage it. Nevertheless, a large
number of this year’s measles cases occurred in ultra-Orthodox
Jewish communities in the neighborhood of Williamsburg in
Brooklyn and in Rockland County, New York. (It’s not just the
Jewish community: the majority of New York City schools with
relatively low rates of measles vaccination among students were
Muslim or Christian academies or alternative-learning institu-
tions.) The outbreak in New York City was declared over in Sep-
tember, but cases have persisted in Rockland County.
Many people who choose not to vaccinate believe no govern-
ment should force them to put medicine into their bodies or
their children’s. They frame the choice as a personal right, but
they are not taking into account the rights of others, including
their own children, to be free of disease. When it comes to bal-
ancing the two, we need to consider the needs of the communi-
ty as well as those of the individual. The Supreme Court ruled in
Jacobson v. Massachusetts that states have the authority to
require vaccination against smallpox, and in Prince v. Massachu-
setts it reaffirmed that the right to religious liberty does not
include the right to expose a child or the community to disease.
Some experts argue we should just make it more difficult to
obtain religious and philosophical exemptions. But unless the
exemptions are removed completely, there will always be people
who want to use them. Partial elimination, as the Washington
State Senate enacted in the case of philosophical exemptions for
the MMR (measles, mumps and rubella) vaccine alone, is also
shortsighted because it sends the message that some immuniza-
tions are less important than others. The only surefire solution is
to eliminate nonmedical exemptions to recommended vaccines.
People who cannot be vaccinated for medical reasons—such as
those with compromised immune systems—should of course
remain exempt. But there is no legitimate argument against vac-
cination for the vast majority of healthy people, and there are
many powerful arguments in favor of it. Refusing to vaccinate is
not a matter of freedom. It’s a matter of public safety.JOIN THE CONVERSATION ONLINE
Visit Scientific American on Facebook and Twitter
or send a letter to the editor: [email protected]© 2019 Scientific American